University of Connecticut



THE UNIVERSITY OF CONNECTICUT

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OFFICE OF THE VICE PRESIDENT FOR RESEARCH

TECHNOLOGY COMMERCIALIZATION SERVICES

SOFTWARE/APP DISCLOSURE FORM

The University of Connecticut, as the state’s publicly supported Land Grant University, has a three-fold mission comprised of Teaching, Research and Service. Creating software and putting it to use for the benefit of the public is one of many ways of contributing to the University’s overall objectives. Accordingly, The University of Connecticut encourages the inventive process and, through the Technology Commercialization Services group (TCS) of the Office of the Vice President for Research (OVPR), assists in bringing software to the point of public use.

PLEASE SUBMIT THE COMPLETED DISCLOSURE FORM TO: Technology Commercialization Services, Office of the Vice President for Research, The University of Connecticut, 400 Farmington Avenue, MC-6400, Farmington, CT 06030-6400. Please email the completed disclosure form (Word document preferred) to Christine McCluskey at: mccluskey@uchc.edu. Any documentation that cannot be transmitted electronically should be mailed. If you have questions, please call Technology Commercialization Services at

(860) 679-3992. A member of TCS will contact you shortly to discuss your software and possible courses of action.

PLEASE NOTE: ALL AUTHORS must complete and sign the AUTHOR SIGNATURE PAGE, which may be mailed to TCS after electronic submittal of a Software/App Disclosure Form.

THE UNIVERSITY OF CONNECTICUT

SOFTWARE/APP DISCLOSURE FORM

Date Received ___________________ Disclosure No. _________

(For use by TCS Staff) (For use by TCS Staff)

Please note: If you feel that the software disclosed here may also be a patentable invention, please be sure to convey this to TCS to ensure that patentable aspects of the software

(for example an algorithm or method) are captured and evaluated.

| | | | |

|(1) LEAD AUTHOR’s |Department |Office Phone |University and email Address |

|Full Name | | | |

|_________________________________ |______________ |_______ |______________________ |

|_________________________________ |______________ |_______ |______________________ |

| | | | |

| | | | |

| | | | |

| | | | |

2) TITLE OF SOFTWARE:

3) BRIEF DESCRIPTION OF THE SOFTWARE:

• State concisely what has been created. What does the software do?

• Please describe key features/characteristics/functionality of the software.

• What are the key advantages/benefits of the software?

• Please provide key dates (e.g. Year the code was first created and When the code was first published).

• How does a user interact with the software (e.g. command line, graphical user interface, etc.)?

• What programming language(s) is the software written in?

• How long would it take someone skilled in your field to recreate the software (i.e. how long would it take someone to write original software that performs the same function[s])?

• If applicable, please provide a link/URL to the source code or information on how it can be accessed.

In addition to the written description, please feel free to attach supporting materials (e.g. data, publications, GUI/workflow screenshots, etc.).

4) COMMERICAL APPLICATION(S)/USERS:

• Briefly state any potential commercial applications of the software.

• Who will the end users be? How will they use this software?

• What commercial entities may be interested in this software?

• At this time, are you aware of any potential barriers/challenges to potential commercialization activities (e.g. any legal considerations, incorporation of element(s) under copyleft license(s), niche market, requirement for highly sophisticated user(s), etc.)?

5) STAGE OF DEVELOPMENT/FUTURE PLANS: Please check which of the following most closely describes the current developmental stage of this software:

| |Planning |

| |Alpha |

| |Beta |

| |Production/Stable |

| |Mature |

• Is this a new version of software that has been previously disclosed?

• Do you plan to continue working on this software (i.e. is there potential for release of improved version(s) moving forward)?

• Is continued support needed for the software? If so, do you plan on providing such support? For how long? Are any resources needed?

• Do you believe that this software could be the foundation for a new company?

6) THIRD PARTY CODE: Please list all third party code that has been used in this software. Please consider all propriety or open source code that is either embedded in or accessed by the software when it is executed. Any code not written by authors, including but not limited to, all open source code, library code, code written by colleagues, or other proprietary code should be listed below. Please feel free to add rows as needed.

“BUILD OF MATERIALS”

|Component |Web Page to Download Code |License [Version] |Web Page Location of Third Party|

|(Name of Third Party Code/Library) | |(e.g. Apache [2.0]) |License |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

7) OPEN SOURCE RELEASE – Part I – LICENSE SELECTION: Have you/or do you have interest in releasing the Source Code under an Open Source License?

For more information and guidance on Open Source License selection and determining component compatibility please visit:



If yes, please indicate the preferred license (select only one):

MIT

BSD 3-Clause

Apache 2.0

GNU GPL, Please specify version: _______________

GNU LGPL, Please specify version: _______________

GNU AGPL, Please specify version: _______________

Creative Commons, Please specify version: _______________

Other, Please specify: _______________

Non-commercial/research use only

Guidance requested

Do NOT intend to release open source

8) OPEN SOURCE RELEASE – Part II - LOCATION: Please indicate where the software is currently/will be housed (please mark all that apply):

Personal Website, Please provide the web address: _______________

Personal/Lab Website (UConn affiliated), Please provide the web address: ______________

Github, SourceForge, or other hosting provider (If Other, Please specify): ______________

Through a Federal Agency (e.g. NIH), Please specify: _______________

Through a Journal/Publication, Please specify: _______________

Other, Please specify: _______________

Do NOT intend to release open source

Please note that if an Open Source release is requested, the “Open Source Endorsement” section of the Author Signature Page must be completed. The endorsement signature should come from the department/center that has primary responsibility for funding and/or development of the software.

9) CONTRACTS/FINANCIAL SUPPORT: Check the funding source(s) for the work that led to the developed software. Please provide a copy of any relevant industrial contracts, such as Sponsored Research Agreements.

• Is the software a deliverable of the contract/grant?

No

Yes

• Does the contract/grant/sponsor require an open source release?

No

Yes: If yes, please be sure to complete Sections (7) and (8) above.

Type Agency/Company Grant/Contract No.

______ Federal* ________________ ___________________

______ Industrial ________________ ___________________

______ Other ________________ ___________________

*Please note that the use of Federal funds requires reporting of any subject invention (i.e. any invention or discovery which is or may be patentable that was conceived or first actually reduced to practice in the performance of work under the contract) to the Federal sponsor. If you feel that the software may encompass a subject invention, please contact TCS for further guidance.

10) POTENTIAL CONFLICTS: To be sure that no other entities might be able to claim ownership of, or any other rights to, this software, please provide copies of any Consulting or other Agreements that are or might be applicable.

In the case that any author (individual/undergraduate/consultant) who has no obligation to assign their rights in IP to UConn has contributed (e.g. providing services/work-for-hire) in creating or writing any portion of the software, evidence that the author has assigned his/her IP rights to UConn must be provided. As needed, please contact TCS for assistance.

AUTHOR SIGNATURE PAGE

Lead AUTHOR’s Full Name: ___________________________

TITLE OF SOFTWARE: ________________________________________________

AUTHOR(S) SIGNATURES: By signing, the author(s) confirm: (1) the completeness and accuracy of the information in this disclosure; (2) to the extent that each author is or may be determined to be a legal inventor of the invention described herein, each UConn author agrees to and does hereby assign all right, title and interest in the invention, related to the software, to the University of Connecticut; (3) the willingness of each UConn author to cooperate fully with TCS and the OVPR during the evaluation, patenting (if appropriate), and commercial development of this invention; and (4) their percent contribution to the conception and development of the invention which will be used to determine each author’s revenue share, regardless of inventorship status. (Inventorship per se is a legal determination based on an individual’s intellectual contribution to the claims in a patent. Its determination must wait until a patent application is filed and will be made with the aid of a patent attorney.) If the percent contribution of each author is not indicated, it will be assumed that each contributed equally. Further, by signing, the author(s) agree to keep TCS/OVPR informed of any changes in their home address. If TCS/OVPR does not have the current address, the signatories agree that any payments otherwise due to them shall be retained by the University of Connecticut.

Please note that a:

“UConn author” is anyone who is employed by UConn who has written any portion of the software. Even small contributions to the code constitute authorship.

By signing below, each author attests to the following:

1) I have fully disclosed all of the third party code and materials that have been embedded in the software described in the present disclosure;

2) In those instances in which the University has an ownership interest in software, I hereby assign all right, title, and interest, including, but not limited to copyright and copyrights in the invention disclosed herein to the University of Connecticut;

3) As applicable, I affirm that I have conducted a license compatibility assessment and to the best of my knowledge, the licenses present in the software (as disclosed in Section 6) are compatible

Note: The “Build of Materials” spreadsheet in Section 6 of this form should be utilized in determining if components are compatible. Visit for further guidance;

4) As applicable, I affirm that I have read the license selected in Section 7 and will, to the best of my ability, remain in compliance with the associated terms and conditions;

5) As applicable, I am in agreement with the requested Open Source Release/distribution model stipulated in Sections 7 and 8 and agree to include the appropriate copyright statement, open source license file, and the General Disclaimer provided by TCS as part of any Open Source Release.

*If you are a Non-UConn Author please complete the second table below.*

Please Note: The Authors’ Percent Contribution, regardless of affiliation, should total 100%.

UConn Authors

| |UConn Author |Percent Contribution |Date Signed |

|1. | | | |

|Print Name: | | |

|Department/Campus: | | |

|Home Address: | | |

| | | |

|Email Address: | | |

|Country of Citizenship: | | |

|Please check one of the following: |

|Faculty: Post-Doc: Grad Student: Undergraduate: Staff: |

|Nature of contribution (please briefly explain your contribution to the software, including if your participation is “work-for-hire” or if you |

|may be a non-author contributor): |

|Signature: |

| |

|2. |UConn Author |Percent Contribution |Date Signed |

|Print or Type Name: | | |

|Department/Campus: | | |

| | | |

|Home Address: | | |

| | | |

|Email Address: | | |

|Country of Citizenship: | | |

|Please check one of the following: |

|Faculty: Post-Doc: Grad Student: Undergraduate: Staff: |

|Nature of contribution (please briefly explain your contribution to the software, including if your participation is “work-for-hire” or if you |

|may be a non-author contributor): |

|Signature: |

*Please feel free to expand the table to accommodate the inclusion of additional authors*

Open Source Endorsement

The request for Open Source Release has been reviewed and endorsed by the following representative with institutional signing authority:

Department/Center: ________________________

Department Chair/Center Head Name (print): ________________________

Department Chair/Center Head Signature: ________________________

Date: ___________________

Non-UConn Authors

|1. |Non-UConn Author |Percent Contribution |Date Signed |

|Print or Type Name: | | |

|Affiliation/Employer: | | |

| | | |

|Home Address: | | |

| | | |

|Email Address: | | |

|Country of Citizenship: | | |

|Please check one of the following: |

|Faculty: Post-Doc: Grad Student: Undergraduate: Staff: |

|Nature of contribution (please briefly explain your contribution to the software, including if your participation is “work-for-hire” or if you |

|may be a non-author contributor): |

| |

|Signature: |

| |

|2. |Non-UConn Author |Percent Contribution |Date Signed |

|Print or Type Name: | | |

|Affiliation/Employer: | | |

| | | |

|Home Address: | | |

| | | |

|Email Address: | | |

|Country of Citizenship: | | |

|Please check one of the following: |

|Faculty: Post-Doc: Grad Student: Undergraduate: Staff: |

|Nature of contribution (please briefly explain your contribution to the software, including if your participation is “work-for-hire” or if you |

|may be a non-author contributor): |

| |

|Signature: |

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